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Antecedentes familiares BBBB 31BBBB 3 BBBB BBBB SDU R FRP BBB DQR O LPR SDU R i BBBBDQR
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Antecedentes pessoais PDPHQ DomR LP QmR UDomR R DO BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
RHQoD BBBBBBBBBBBBBBBBBBBBBBBB 2E HU Do H BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
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Antecedentes ginecológicos

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Exulceração, ulceração, ssura...
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3RU PHLR GD LQVSHomR
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5HWDO 36ºC – 37,5ºC VXGRUHQWD
8PLGDGH
3RU PHLR GD LQVSHomR H SDOSDomR FRP DV
Fonte: Semiologia Médica – Porto, 2014.
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Quanto à febre, sua intensidade pode ser classi cada em Normal, lisa/ na, áspera ou enrugada
OHYH PRGHUDGD H DOWD GH DFRUGR FRP D WHPSHUDWXUD D LODU 7H WXUD 3RU PHLR GR GHVOL DPHQWR GDV SROSDV GLJLWDLV
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Fonte: Semiologia médica – Porto, 2014.
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3RU PHLR GR XVR GH VH HQFRQWUDP VHQWDGRV RX HP Sp XP HP IUHQWH
OWHUDo HV GH FRU HOHYDo HV HGHPDWRVDV DR RXWUR 1HVVD WpFQLFD RV SROHJDUHV H DPLQDP D
IRUPDo HV VyOLGDV FROHo HV OtTXLGDV JOkQGXOD HQTXDQWR RV GHPDLV GHGRV VmR DSRLDGRV QD
/HV HV HOHPHQWDUHV DOWHUDo HV GD HVSHVVXUD RX SHUGD H UHSDUDo HV UHJLmR VXSUDFODYLFXODU
WHFLGXDLV
• Abordagem anterior: QHVVD DERUGDJHP DQWHULRU
3RU PHLR GD LQVSHomR H GD SDOSDomR
DV SRVLo HV GR PpGLFR H SDFLHQWH VmR DV PHVPDV
0 26 6 Mi GHVFULWDV HQWUHWDQWR D JOkQGXOD p SDOSDGD FRP
5 7(5 67 6
35 1 3 6 5 (6 ( 202 apenas uma mão por vez e é feita a exão ou
(7(50 1 / 6 OHYH URWDomR GR SHVFRoR SDUD UHOD DU R P VFXOR
1RUPRFRUDGDV UyVHR DYHUPHOKDGDV HVWHUQRFOHLGRPDVWyLGHR
KLSRFRUDGDV KLSHUFRUDGDV FLDQyWLFDV
RORUDomR LFWpULFDV RX OHXFRSOiVLFDV FIGURA 2.1 – Exame da tireoide (abordagem anterior).
3RU PHLR GD LQVSHomR
8PLGDGH QRUPDO LQGLFDomR GH KLGUDWDomR RX
8PLGDGH PXFRVDV VHFDV LQGLFDomR GH GHVLGUDWDomR
3RU PHLR GD LQVSHomR

)RQWH GRV DGRV 32572 XOD

( 0( 7 5(2 (

2 H DPH GD WLUHRLGH p UHDOL DGR SRU PHLR GD LQVSHomR

SDOSDomR H DXVFXOWD IRUPD H R WDPDQKR GD JOkQGXOD VmR
de nidos ao inspecionar e palpar o paciente, sendo importante
GHVFUHYHU HP FDVR GH DXPHQWR VH p JOREDO RX ORFDOL DGR
HYHP VHU GHVFULWRV DLQGD DOpP GDV GLPHQV HV RV OLPLWHV D )RQWH UTXLYR GRV DXWRUHV
FRQVLVWrQFLD D PRELOLGDGH DR GHJOXWLU D SUHVHQoD GH QyGXORV D
WHPSHUDWXUD H D SUHVHQoD GH IUrPLWR RX VRSUR
( dPH I VlfR GdV PdPdV
► 3DOSDomR
( LVWHP GLIHUHQWHV WpFQLFDV GH SDOSDomR WLUHRLGLDQD 1 720 60 0 6
GHQWUH HVVDV DV PDLV FRPXQV VmR
• Abordagem Posterior: R SDFLHQWH VH HQFRQWUD ► (VWUXWXUDV
VHQWDGR H R PpGLFR HP Sp DWUiV GR PHVPR 1HVVD • Papila: SURMHomR QRUPDOPHQWH QR HVSDoR
WpFQLFD D PmR HVTXHUGD GR H DPLQDGRU SDOSD R ORER LQWHUFRVWDO WDQWR HP KRPHQV FRPR HP PXOKHUHV
GLUHLWR GD WLUHRLGH HQTXDQWR D PmR GLUHLWD DIDVWD R
• Aréola: SHOH HQUXJDGD TXH FLUFXQGD D SDSLOD
P VFXOR HVWHUQRFOHLGRPDVWyLGHR H R FRQWUiULR SDUD
 • Cauda de Spence: SURORQJDPHQWR GR WHFLGR • 7dPdQ R Gd PdPd SHTXHQD PpGLD JUDQGH
PDPiULR HP GLUHomR D LODU KLSHUSOiVLFD
• Glândulas ou tubérculos de Montgomery: • 6lPHWUld VLPpWULFDV RX DVVLPpWULFDV
glândulas areolares que cam aumentadas durante • )RUPdWR F QLFD FRQYH D SHQGXODU SHQGXODU
D JUDYLGH PXOKHU JUDYtGLFD RX GXUDQWH D ODFWDomR YROXPRVD
PXOKHU SXUSHUDO
• )RUPdWR Gd SdSlOd SURWXVDV VHPL SURWXVDV
► LYLVmR DQDW PLFD SODQDV LQYHUWLGDV UHWUDtGDV
(P TXDWUR TXDGUDQWHV DGLFLRQDQGR PDLV XP R FHQWUDO • RU Gd dUpROd URVD PDUURP SUHWD
FRP D DUpROD H R PDPLOR • 3HOH VH SRVVXL HGHPD HULWUHPD FLFDWUL RX VH p
• 6XSHUR ODWHUDO VXSHULRU H WHUQR 46/ QRUPDO

• 6XSHUR PHGLDO VXSHULRU LQWHUQR 460
• ,QIHUR ODWHUDO LQIHULRU H WHUQR 4,/
• ,QIHUR PHGLDO LQIHULRU LQWHUQR 4,0
• 4XDGUDQWH FHQWUDO UHWUR DUHRODU
FIGURA 2.2 – Divisão anatômica das mamas.
• 3UHVHQod GH Q GxORV lV HlV (tumores super ciais
DFLPD GH FP
Observação:
FRU GD DUpROD p QRUPDOPHQWH PDLV HVFXUD TXH R WRP GH SHOH SRLV WUDWD
VH GH XPD UHJLmR FRP PDLV PHODQyFLWRV 1R VHJXQGR PrV GH JHVWDomR
Ki PDLRU HVFXUHFLPHQWR TXH SRGH SHUVLVWLU HP JUDXV YDULiYHLV

FIGURA 2.3 – Inspeção estática.

)RQWH UTXLYR GRV DXWRUHV

)RQWH UTXLYR GRV DXWRUHV

163( 2 (67 7
OJXPDV DOWHUDo HV
Posição: VHQWDGD RX HP Sp FRP RV EUDoRV DR ORQJR GR FRUSR
• Amastia: DXVrQFLD FRQJrQLWD XQL RX ELODWHUDO GH
GDQGR SUHIHUrQFLD TXH HVWHMD VHQWDGD SDUD FRQIRUWR GD SDFLHQWH
JOkQGXOD PDPiULD
Observar:
• Polimastia: JOkQGXODV PDPiULDV D PDLV QD OLQKD
• 1 PHUR PDPDV H PDPLOR OiFWHD UHJLmR D LODU D UHJLmR LQJXLQDO
 • Atelia: DXVrQFLD FRQJrQLWD GR PDPLOR ), 85 0RYLPHQWRV SDUD PDPDV GH PDLRU YROXPH H%
• Politelia: PDPLORV H WUDV VHP JOkQGXOD PDPiULD
Em adolescentes: UHDOL DU R HVWDGLDPHQWR GH 7DQQHU

163( 2 1 0

Posição: HP Sp RX VHQWDGD SHGLU SDUD SDFLHQWH UHDOL DU

movimentos:
• RLV GHOHV DOWHUDP D WHQVmR QRV OLJDPHQWRV
VXVSHQVRUHV GD PDPD TXH VmR
• (UJXHU RV EUDoRV D )RQWH UTXLYR GRV DXWRUHV
• (UJXHU RV EUDoRV D Observar:
FIGURA 2.4 – Movimento em 180º. • EDXODPHQWRV
• Retrações (são retrações do tecido broso, e podem
signi car tumor).
• 0RELOLGDGH GD JOkQGXOD PDPiULD QRUPDO GLPLQXtGD
RX DXVHQWH

3 /3 2

Posição: HP Sp RX GHF ELWR GRUVDO FRP DV PmRV QD FDEHoD

Melhor período para fazer a palpação: ORJR DSyV R
m da menstruação, em mulheres não histerectomizadas em
PHQDFPH SHVDU GH H LVWLU XP SHUtRGR PDLV IDYRUiYHO D
SDOSDomR GHYH VHU IHLWD HP WRGDV DV FRQVXOWDV (VVD LQIRUPDomR
WRUQD VH WLO TXDQGR Ki G YLGD GLDJQyVWLFD
Técnicas: SRGH VHU IHLWD FRP XPD RX GXDV PmRV H YiULRV
)RQWH UTXLYR GRV DXWRUHV
VHQWLGRV GHVGH TXH SDOSD VH WRGRV RV TXDGUDQWH RPR SRU
► 2V RXWURV GRLV VmR PDLV XWLOL DGRV SDUD DYDOLDU PDPDV H HPSOR: )D HU R H DPH GH DPERV RV ODGRV GD SHULIHULD SDUD
com maior volume, que devem car pêndulas durante R FHQWUR HP WRGRV RV TXDGUDQWHV QR VHQWLGR KRUiULR DOpP GD
VXD H HFXomR FDXGD GH 6SHQFHU H DFLPD GR PDPLOR

• ,QFOLQDU VH SDUD IUHQWH R RPEUR SUHVVLRQDQGR DV • Vealpeau: PmR HVSDOPDGD

PmRV FRP IRUoD XPD FRQWUD D RXWUD • Blood Good: SRQWDV GRV GHGRV
• ,QFOLQDU VH SDUD IUHQWH FRP DV PmRV QD DVD GR LOtDFR
SUHVVLRQDQGR FRP IRUoD
FIGURA 2.6 – Técnica de Vealpeau. Achados:
• Aspecto granuloso (grãos de areia): p XP DFKDGR
FRPXP H QRUPDO
• Fibroadenoma: móvel, limites bem de nidos e
consistência broelástica (benigno). Pedir ultrassom
H DFRPSDQKDU SRGH WHU FRQVLVWrQFLD HQGXUHFLGD HP
caso de broadenoma calci cado).
• Nódulos xos ou aderidos, com limites mal
de nidos e consistência pétrea: VXJHVWLYR GH
QHRSODVLD 6H D PXOKHU HVWLYHU HP SyV PHQRSDXVD
pedir mamogra a, pois ela tem boa resolução em
PDPD DGLSRVD WtSLFR GH PXOKHUHV SyV PHQRSDXVD
Se a mulher for jovem, pedir ultrassom e mamogra a
FRPSOHPHQWDU SRUTXH QR WHFLGR JODQGXODU GH PDPDV
)RQWH UTXLYR GRV DXWRUHV mais jovens, a mamogra a não tem boa resolução.
1D SUHVHQoD GH QyGXORV RX FRQGHQVDomR VHPSUH DQDOLVDU
FIGURA 2.7 – Técnica de Blood Good.
H GHVFUHYHU VXDV FDUDFWHUtVWLFDV
• /lPlWHV (se não for de nido, é indicativo de
PDOLJQLGDGH VH IRU EHP GHOLPLWDGR WHQGH D VHU
EHQLJQR
• RQVlVWrQfld D FRQVLVWrQFLD PDLV HQGXUHFLGD p
VXJHVWLYD GH PDOLJQLGDGH
• 0RelOlGdGH SRXFR LQGLFD PDOLJQLGDGH
• GHUrQfld d HVWUxWxUdV VxeMdfHQWHV TXH SRGH VHU
YLVWD SHOD EDL D PRELOLGDGH QD LQVSHomR GLQkPLFD
• l PHWUR SRGH DX LOLDU QR HVWDGLDPHQWR GD
QHRSODVLD

( 35(66 2
)RQWH UTXLYR GRV DXWRUHV

Observar: Técnica: UHDOL D VH D PDQREUD GR JDWLOKR TXH FRQVLVWH

QD FRPSUHVVmR GD DUpROD HP VHQWLGR FHQWUtSHWR HP YiULDV
• RQVlVWrQfld GR SdUrQtxlPd KRPRJrQHR RX GLUHo HV HP DPEDV DV PDPDV
JUDQXORVR
• Positivo: VHFUHomR SDSLODU
• 3UHVHQoD GH FRQGHQVDo HV RX QyGXORV
• Negativo: VHP VHFUHomR
• 7HPSHUDWXUD H YROXPH GR SDQtFXOR DGLSRVR
FIGURA 2.8 – Expressão da mama. • 3HGLU SDUD D SDFLHQWH YLUDU D FDEHoD SDUD R ODGR TXH
HVWi VHQGR SDOSDGR H OHYDQWDU R PHVPR RPEUR SUD
UHOD DU D PXVFXODWXUD
• /LQIRQRGRV Vy VmR SDOSiYHLV QHVWD UHJLmR HP FDVR GH
FkQFHU DYDQoDGR
► )RVVD LQIUDFODYLFXODU
• 5RWDomR GRV GHGRV QD UHJLmR
• 3DFLHQWH QD PHVPD SRVLomR DQWHULRU LQFOLQDQGR D
FDEHoD SDUD IUHQWH
► 3DUDHVWHUQDLV
• 0HVPR PRYLPHQWR GH DQWHULRU GH URWDomR GRV GHGRV
PDV QDV UHJL HV ODWHUDLV DR HVWHUQR SDUDHVWHUQDLV

)RQWH UTXLYR GRV DXWRUHV FIGURA 2.9 – Palpação sequencial dos linfonodos (A)
VXSUDFODYLFXODUHV % LQIUDFODYLFXODUHV SDUDHVWHUQDLV H
Descrever secreção, se presente:
D LODUHV
• VSHfWR SXUXOHQWR VHURVR VHURVVDQJXtQHR OHLWRVR
DPDUHOR HVYHUGHDGR HVSHVVR
• )UHtxrQfld HVSRQWkQHR LQWHUPLWHQWH RX UHFRUUHQWH
• QlOdWHUdO Rx elOdWHUdO

3 /3 2 ( 1 / 26 OlQIdGHQRPH dOld

Descrever: WDPDQKR Q PHUR IRUPD PRELOLGDGH ERUGDV

GHOLQHDGDV H VH GRU j SDOSDomR
Na ordem:
► kQJOLRV D LODUHV
• Posição: sentada, com antebraço etido e braço em
DEGXomR 0mRV VXVWHQWDGDV QR RPEUR GR PpGLFR 2
H DPH p IHLWR FRP D PmR FRQWUDODWHUDO HVSDOPDGD
• /LQIRQRGRV DXPHQWDGRV SRGHP VHU GHFRUUHQWHV GH
processos in amatórios nos membros superiores.
)RQWH UTXLYR GRV DXWRUHV
• /LQIRQRGRV YROXPRVRV H DGHULGRV SRGHP VHU
GHFRUUHQWHV GH SURFHVVRV PDOLJQRV 2eVHU do HV
► )RVVD VXSUDFODYLFXODU • /RFDOL DU TXDOTXHU OHVmR GDV PDPDV SHOR PpWRGR GR UHOyJLR
• HGRV HQFXUYDGRV SDUD JLUDU QD IRVVD QD TXDO D DQJXODomR p UHSUHVHQWDGD SHOD KRUD
 • 6HPSUH GHVFUHYHU TXDO D ODWHUDOL DomR GD OHVmR FIGURA 2.10 – Materiais necessários ( NOL
• 9DORUL DU D GRU GD SDFLHQWH FDUDFWHUL i OD H UHODFLRQi OD
FRP R SHUtRGR PHQVWUXDO H FRP D PRYLPHQWDomR SDUD
GLIHUHQFLDU GH GRU RVWHRPXVFXODU SRU H HPSOR
• DU SUHIHUrQFLD SDUD UHDOL DU SRU OWLPR QR H DPH R
local dolorido ou de in amação.

( dPH I VlfR Gd xO d H ROSRflWROR ld 2Qf Wlfd

► 0DWHULDO QHFHVViULR
• )RFR GH OX
• 0HVD JLQHFROyJLFD
• %DQFR JLUDWyULR
)RQWH UTXLYR GRV DXWRUHV
• /XYDV GH SURFHGLPHQWR
• %ROLQKDV GH DOJRGmR
Postura do examinador: R H DPLQDGRU GHYH HVWDU YHVWLGR
• 3LQoD KHUURQ DGHTXDGDPHQWH FRP MDOHFR OLPSR H EHP SDVVDGR VDSDWR
• (VFRYLQKD HQGRFHUYLFDO IHFKDGR FDEHORV SUHVRV DGHTXDGDPHQWH XQKDV DSDUDGDV H
OLPSDV HYH VH XWLOL DU OXYDV GH SURFHGLPHQWR SDUD R H DPH
• (VSiWXOD GH UH
HYHUi UHDOL DU VH GH SUHIHUrQFLD R H DPH HVSHFXODU VHQWDGR
• /XJRO VROXomR LRGR LRGHWDGD H R WRTXH HP SRVLomR RUWRVWiWLFD
• Soro siológico (7).
FIGURA 2.11 – Mesa de exame (paciente em posição de
• 5HFLSLHQWH SDUD OkPLQD GH YLGUR FRP iOFRRO ou xador OLWRWRPLD EDQFR JLUDWyULR H IRFR GH OX
spray de polietilenoglicol (para xação da citologia) (8).
• Lâmina de vidro com borda fosca (para identi cação
FRP DV LQLFLDLV GD SDFLHQWH
(VSpFXOR YDJLQDO GH ROOLQV 2 HVSpFXOR SRVVXL TXDWUR
WDPDQKRV YLUJHP SHTXHQR PpGLR H JUDQGH TXH
GHYHP VHU HVFROKLGRV OHYDQGR HP FRQVLGHUDomR RV VHJXLQWHV
FULWpULRV
• ,GDGH 4XDQWR PDLV DYDQoDGD j LGDGH PHQRU GHYH
VHU R HVSpFXOR
• 3DULGDGH 4XDQWR PDLRU o número de lhos (parto
QRUPDO PDLRU GHYH VHU R HVSpFXOR
• 2EHVLGDGH 4XDQWR PDLRU D FLUFXQIHUrQFLD DEGRPLQDO
PDLRU R HVSpFXOR )RQWH UTXLYR GRV DXWRUHV
 163( 2 (67 7
Técnica: SDUD PHOKRU YLVXDOL DomR GHYH VH UHDOL DU XPD
WUDomR GRV JUDQGHV OiELRV FRP RV GHGRV SROHJDU H LQGLFDGRU HP
IRUPD GH SLQoD HYH VHU UHDOL DGD FRP D SDFLHQWH QD SRVlomR
GH OlWRWRPld JLQHFROyJLFD SDUD REVHUYDU
• 5RWXUDV JUDX ,, OHVmR DSRQHXUyWLFD H PXVFXODU
SUHVHUYDQGR HVItQFWHUHV
• 5RWXUD JUDX ,,, OHVmR DWLQJH R HVItQFWHU H WHUQR GR
kQXV
• 5RWXUD JUDX ,9 OHVmR DWLQJH D PXFRVD UHWDO DQWHULRU

► Pili cação do monte de Vênus: formato ginecoide (tem a ► QXV SURFXUD VH KHPRUURLGDV SOLFRPDV HVSHVVDPHQWR
forma triangular com base voltada para cima – triangulo hipertro a da pele perianal), ssuras, prolapso da
LQYHUWLGR PXFRVD H PDOIRUPDo HV

► )HQGD YXOYDU FIGURA 2.12 – Anatomia da vulva.

• )HFKDGD
• (QWUHDEHUWD
• EHUWD
• 3UHVHQoDV GH VHFUHo HV RX KLSHUHPLDV UHJL HV
DYHUPHOKDGDV
► Formação dos grandes lábios: normais ou atró cos
SRGH DFRQWHFHU QR FOLPDWpULR
► Pequenos lábios hipertró cos ou assimétricos.
► 9HVWtEXOR YXOYDU UHJLmR DEDL R GR SHTXHQRV OiELRV
• 2ULItFLR GDV JOkQGXODV GH VNHQH SDUDXUHWUDLV
)RQWH UTXLYR GRV DXWRUHV
• OLWyULV
• 0HDWR XUHWUDO Observação:

• 2ULItFLR GDV OkQGXODV GH %DUWKROLQ • Posição de litotomia: SDFLHQWH HP GHF ELWR GRUVDO
FRP D FDEHoD H RV RPEURV OLJHLUDPHQWH HOHYDGRV V
► +tPHQ coxas devem estar bem exionadas sobre o abdômen
• (OiVWLFR H DIDVWDGDV XPD GD RXWUD
• ,QWDFWR
• DU QFXODV KLPHQDLV HQFRQWUDGR DSyV UHODomR 163( 2 1 0
VH XDO
Técnica: H DPLQDGRU UHDOL D QRYDPHQWH D WUDomR GRV
• DU QFXODV PLUWLIRUPHV DSyV SDUWR QDWXUDO JUDQGHV OiELRV FRP RV GHGRV SROHJDU H LQGLFDGRU HP IRUPD GH
• 3HUtQHR UHJLmR HQWUH D YXOYD H kQXV SLQoD H VROLFLWDU TXH UHDOL H D PdQReUd GH dOVdO d FDVR D
SDFLHQWH QmR FRQVLJD UHDOL DU SRGH SHGLU SDUD ID HU IRUoD FRPR
► 2EVHUYDU SRVVtYHLV FLUXUJLDV
VH IRVVH HYDFXDU SDUD SHVTXLVDU GLVWRSLDV ORFDOL DomR DQRUPDO
• Epsiorra as, ou perineoplastias. GH XP yUJmR RX HVWUXWXUD FRPR SURODSVR YDJLQDO DQWHULRU
• 5RWXUDV JUDX , OHVmR GR SODQR FXWkQHR PXFRVR FLVWRFHOH SURODSVR YDJLQDO SRVWHULRU UHWRFHOH RX SURODSVR
XWHULQR XWHURFHOH
FIGURA 2.13 – Inspeção ginecológica dinâmica. YDJLQD H FRPSUHVVmR GD SDUHGH YDJLQDO DQWHULRU FRP REVHUYDomR
GD VDtGD GH VHFUHomR SXUXOHQWD DWUDYpV GR yVWLR GD XUHWUD H GH
JOkQGXODV SDUDXUHWUDLV

FIGURA 2.15 – Expressão da parede vaginal anterior.

)RQWH UTXLYR GRV DXWRUHV

3 /3 2
)RQWH UTXLYR GRV DXWRUHV
Técnica: R H DPLQDGRU SDOSD WRGD D H WHQVmR GD YXOYD
tentando identi car tumores, cistos (de glândula de Bartholin -
%DUWKROLQLWH H OLQIRQRGRV GH YXOYD ( 0( (63( / 5

FIGURA 2.14 – Palpação ginecológica. Técnica: UHDOL DGR QD SRVLomR GH OLWRWRPLD FRP DV PmRV
HQOXYDGDV OXYDV GH SURFHGLPHQWR GHYH VH UHDOL DU D LQWURGXomR
GR HVSpFXOR 2 H DPLQDGRU VHQWDGR

QWURGxomR GR HVSpfxOR

HYHP VH DIDVWDU RV JUDQGHV H SHTXHQRV OiELRV FRP R

SROHJDU H GHGR GD PmR HVTXHUGD SDUD TXH R HVSpFXOR
VHMD LQWURGX LGR VXDYHPHQWH QD YDJLQD
PmR GLUHLWD TXH LQWURGX LUi R HVSpFXOR GHYH VHJXUi OR
SHOR FDER
2 HVSHFXOR p LQWURGX LGR IHFKDGR FRP R SLQR SDUD EDL R
SRLD VH R HVSpFXOR VREUH D I UFXOD OLJHLUDPHQWH REOtTXR
– para evitar trauma uretral – e faz-se sua introdução
)RQWH UTXLYR GRV DXWRUHV OHQWDPHQWH
QWHV GH VHU FRPSOHWDPHQWH FRORFDGR QD YDJLQD GHYH VHU
( 35(66 2
rodado, cando as valvas paralelas às paredes anterior e
SRVWHULRU GD YDJLQD 3RVLomR TXH RFXSDUi QR H DPH H R SLQR
Técnica: H SUHVVmR GD XUHWUD H GDV JOkQGXODV SDUDXUHWDLV
SDUD EDL R
DWUDYpV GD LQWURGXomR GR GHGR LQGLFDGRU QR XP WHUoR H WHUQR GD
 6HJXUDU FRP D PmR HVTXHUGD R FDER H URGD R SLQR FRP D • 3XUXOHQWR
PmR GLUHLWD • 6DQJXLQROHQWR
EULU R HVSpFXOR HQFDL DQGR FXLGDGRVDPHQWH QR FROR GR WHUR
Observação:
FIGURA 2.16 – Introdução do espéculo vaginal de Collins (A e B). Na presença de corrimento, veri car: quantidade, cor, odor, bolhas
e sinais in amatórios associados.

FIGURA 2.17 – Presença de junção escamo-colunar (JEC) com

HFWRSLD PiFXOD UXEUD

)RQWH UTXLYR GRV DXWRUHV

O exame especular deve ser realizado:

► HVFUHYHQGR DV SDUHGHV YDJLQDV

• 5XJRVLGDGH RX OLVDV
• 3UHVHQoD GH VHFUHo HV
• RPSULPHQWR H HODVWLFLGDGH )RQWH UTXLYR GRV DXWRUHV
► DUDFWHUtVWLFDV GR FROR
Ectopia: R WHUPR p XWLOL DGR TXDQGR D -( -XQomR HVFDPR
• 9ROXPH FROXQDU HQFRQWUD VH DOpP GR OLPLWH DQDW PLFR GR FDQDO FHUYLFDO
• RORUDomR QD UHJLmR HFWRFHUYLFDO 2 HSLWpOLR p HFWySLFR SRLV R HSLWpOLR
FROXQDU HQFRQWUD VH DOpP GRV VHXV OLPLWHV DQDW PLFRV
• )RUPD FLOtQGULFR RX SODQR
Observação: ORJR DSyV D FRORFDomR GR HVSpFXOR GHYH VH
• (SLWHOL DGR RX FRP PiFXOD UXEUD HFWRSLD
coletar o exame citopatológico e após limpar com soro siológico
► )RUPD GR RULItFLR H WHUQR 2( PXFROtWLFR UHDOL DU R WHVWH GR ,RGR WHVWH GH 6FKLOOHU
• 3XQWLIRUPH
2/32 72/2 21 7
• LUFXODU
(Preventivo de Câncer de Colo de Útero – PCCU ou Papanicolau)
• 7UDQVYHUVR
► 0DWHULDLV QHFHVViULRV SDUD R SURFHGLPHQWR
► VSHFWR GR PXFR FHUYLFDO
• /x d GH 3URfHGlPHQWR
• 7UDQVO FLGR
• Algodão: SDUD DSOLFDomR GDV VROXo HV H OLPSH D GR
• (VEUDQTXLoDGR ORFDO
 • (VSpfxOR d lQdO ROOlQV SDVVDU QD OkPLQD VRPHQWH DSyV D FROHWD GD HQGRFpUYLFH
• Espátula de Ayre: p XP LQVWUXPHQWR XWLOL DGR SDUD HYLWDU TXH UHVVHTXH R PDWHULDO
DWXDOPHQWH SDUD D REWHQomR GR PDWHULDO FHUYLFDO FIGURA 2.19 – Coleta do material da ectocérvice com a espátula
FROR GR WHUR 2 IRUPDWR GD HVSiWXOD p LGHDO SDUD D GH UH
DPRVWUDJHP GD VXSHUItFLH HFWRFHUYLFDO
• Escovinha endocervical: HVFRYD DORQJDGD XVDGD
QR FDQDO GR FROR XWHULQR SDUD REWHU DPRVWUDJHP GH
PDWHULDO GD HQGRFpUYLFH
• Pinça Cherron: instrumental utilizado para xa o
DOJRGmR H DX LOLDU QD OLPSH D H XVR GH VXEVWkQFLD

FIGURA 2.18 – Empunhadura da pinça Cherron.

)RQWH UTXLYR GRV DXWRUHV

8VDU D HVFRYLQKD HQGRFHUYLFDO SDUD ID HU D FROHWD GD

HQGRFpUYLFH GDU XPD YROWD GH UHWLUDU D HVFRYLQKD H
então passar na lâmina de vidro identi cada com o nome
GD SDFLHQWH GR ODGR GD ERUGD IRVFD
)RQWH UTXLYR GRV DXWRUHV
FIGURA 2.20 – Coleta de material da endocérvice com escovinha
• / PlQd GH lGUR GH eRUGd IRVfd H UHflSlHQWH SdUd HQGRFHUYLFDO
lâmina de vidro: SODFD XVDGD QD FROHWD H SHVTXLVD
GDV DPRVWUDV VHQGR REULJDWyULD D identi cação GD
SDFLHQWH
• Soro siológico: DomR PXFROtWLFD SDUD OLPSH D GR
FROR H GD YDJLQD
• Lugol: VROXomR LRGR LRGHWDGD FRP SURSULHGDGHV GH
UHDJLU QD SUHVHQoD GH PXFRSROLVVDFDUtGHRV FRPR
PLGR JOLFRJHQLR GH WULQD 8VDGR QR WHVWH GH
6FKLOOHU RX WHVWH GR ,RGR
► 1R PRPHQWR GD UHDOL DomR GR 3DSDQLFRODX H DPH
FLWRSDWROyJLFR
8VDU D HVSDWXOD GH UH SDUD ID HU D FROHWD GD HFWRFpUYLFH
JLUDU DR UHGRU GR FROR GR WHUR FRORFDQGR D SDUWH
PDLV ORQJD QR FDQDO UHWLUDU H VHJXUDU FRP D RXWUD PmR )RQWH UTXLYR GRV DXWRUHV
 3DVVDU D HVSiWXOD GH D UH H GD HVFRYLQKD HQGRFHUYLFDO QD
OkPLQD GH YLGUR QR ODGR GD ERUGD IRVFD QD UHJLmR RQGH
não tem nenhum material e xar o material na lâmina de
vidro identi cada com álcool 96 HP XP IUDVFR RX VSUD GH
SROLHWLOHWRQJOLFRO
FIGURA 2.21 – Fixação do material na lâmina de vidro (A) da
HFWRFpUYLFH H % GD HQGRFpUYLFH
QDOLVDU R FROR H YDJLQD
VROXomR UHDJH FRP R JOLFRJrQLR SROLVVDFDUtGHRV ULFDPHQWH
presente no citoplasma das células super ciais e intermediárias)
GDQGR D FRORUDomR PDUURP HVFXUD FRORUDomR p SURSRUFLRQDO D
TXDQWLGDGH GH JOLFRJrQLR FRUDQGR IRUWHPHQWH DV FpOXODV GD FDPDGD
super cial e intermediárias e de maneira mais clara as células basais
(epitélio atró co) e colunares (glandulares). Logo, é siológico o
colo do útero corar com o iodo e car com a coloração marrom.
► 2 WHVWH SRGH VH DSUHVHQWDU
• Teste iodo positivo (Schiller Negativo): VLWXDomR
QRUPDO FRU DFDVWDQKDGR HVFXUR

FIGURA 2.22 – Colo normal antes da solução de iodo (A) e Teste

do iodo positivo – Schiller negativo (B).

)RQWH UTXLYR GRV DXWRUHV

Observação: SOLFDU R PDWHULDO QD OkPLQD GH YLGUR SDVVDQGR

DSHQDV XPD YH GH IRUPD KRPRJrQHD QmR HVSHVVDGD H XP
PDWHULDO DR ODGR GR RXWUR
)RQWH UTXLYR SHVVRDO GH QD DUOD UD MR DPSRV

7(67( 2 2 2 6f lOOHU • Teste iodo negativo (Schiller Positivo): FRORUDomR

DPDUHODGR PRVWDUGD H FRP ERUGDV EHP GHOLPLWDGDV
2 WHVWH GH 6FKLOOHU p UHDOL DGR DSyV D FROHWD GR 3DSDQLFRODX UHDOL DU FROSRVFRSLD H ELySVLD GD iUHD 6mR FDVRV GH
SDUD QmR LQWHUIHULU QR UHVXOWDGR GR H DPH PXOKHU DLQGD OHV HV DWtSLFDV 0RVDLFR HSLWpOLR EUDQFR OHXFRSODVLD
HVWDUi QD SRVLomR GH OLWRWRPLD H FRP R HVSpFXOR GH ROOLQV ou representar in ltração de células carcinomatosas.
Técnica:
FIGURA 2.23 – Colo alterado antes da solução de iodo (A) e
Aplicar a solução de soro siológico diretamento no colo Teste do iodo negativo – Schiller positivo (B).
XWHULQR
8WLOL DU D SLQoD GH KHUURQ FRP DOJRGmR SDUD HVSDOKDU R
PDWHULDO
5HWLUDU H GHVFDUWDU DOJRGmR
SOLFDU D VROXomR GH /XJRO LRGR LRGHWDGD QD UHJLmR GR FROR
XWHULQR H YDJLQD
(VSDOKDU QRYDPHQWH FRP DOJRGmR QD SLQoD GH KHUURQ
)RQWH UTXLYR SHVVRDO GH QD DUOD UD MR DPSRV
Descrição (exemplo): 724 (
FIGURA 2.24 – Colo iodo negativo ou Schiller positivo às 3 e 6 Técnica: SDFLHQWH DLQGD QD SRVLomR OLWRW PLFD FRP R
K j GLUHLWD DOWHUDGR SROHJDU GHGR GD PmR GRPLQDQWH IDUmR R DIDVWDPHQWR
GRV SHTXHQRV OiELRV GD YXOYD H HQWmR LQWURGX LU R H R
GHGRV 2 WRTXH SRGH VHU UHDOL DGR GH PDQHLUD XQLPDQXDO
WRTXH VLPSOHV RX ELPDQXDO FRPELQDGR 2 H DPLQDGRU
GHYHUi HVWDU HP SRVLomR RUWRVWiWLFD

FIGURA 2.25 – Técnica do Toque vaginal.

)RQWH UTXLYR GRV DXWRUHV

Observações:
• -( MXQomR HVFDPR FROXQDU GHYHUi HVWDU QR 2(
)RQWH UTXLYR GRV DXWRUHV
RULItFLR H WHUQR GR FROR XWHULQR iUHD GH WUDQVLomR GR
iodo positivo (epitélio escamo estrati cado- ectocérvice ► 1R WRTXH XQLPDQXDO RX VLPSOHV DYDOLD VH
e vagina) com iodo claro (epitélio colunar – endocérvice). • V SDUHGHV GD YDJLQD REVHUYDQGR D HODVWLFLGDGH D
OpP GR 2( D -( WDPEpP SRGH HVWDU QD HFWRFpUYLFH RX FDSDFLGDGH D H WHQVmR D VXSHUItFLH DV LUUHJXODULGDGHV
HQGRFpUYLFH D VHQVLELOLGDGH H D WHPSHUDWXUD
• 0XOKHUHV QR FOLPDWpULR SRGHP DSUHVHQWDU DUHDV QmR • 2V IyUQLFHV SUHVHQoD GH WXPRUDomR
FRUDGDV RX GH PRVDLFLVPR GHYLGR D IDOWD GH HVWURJrQLR
VHP HVWDU FRP TXDOTXHU DOWHUDomR QHFHVVLWDQGR ► ROR XWHULQR
DGPLQLVWUDomR GH HVWURJrQLR H UHSHWLU R H DPH • 0RELOL DQGR R SUHVHQoD GH GRU

► 5HWLUDGD GR HVSpFXOR • 3RVLomR GR PHVPR DQWHULRU SRVWHULRU RX ODWHUDOL DGR

Ao nal, depois de realizar inspeção, coleta da colpocitologia • Consistência: broelástica (semelhante a cartilagem
H WHVWH GR ,RGR R HVSpFXOR YDJLQDO GHYHUi VHU UHWLUDGR QDVDO QmR JUiYLGD H DPROHFLGR VHPHOKDQWH DR OiELR
TXDQGR JUiYLGD
3DUD UHWLUDU R HVSpFXOR WUDFLRQDU FXLGDGRVDPHQWH R
HVSpFXOR SDUD OLEHUDU R FROR XWHULQR
1D UHWLUDGD REVHUYDU DV SDUHGHV GD YDJLQD
)HFKDU OHQWDPHQWH R HVSpFXOR YROWDGR D SRVLomR GH HQWUDGD
H IHFKDQGR DV YDOYDV
FIGURA 2.26 – Toque unimanual ou simples. • 7XPRUDo HV
• QH RV SDOSiYHLV VH GRU WXEDV H RYiULRV FDVR QmR
WHQKR GRU QHP WXPRU FRQVLGHUDU RV DQH RV OLYUHV

), 85 YDOLDomR GRV DQH RV WRTXH ELPDQXDO RX

FRPELQDGR

)RQWH UTXLYR GRV DXWRUHV

► 7RTXH ELPDQXDO FRPELQDGR

5HDOL DU R WRTXH FRP R DX LOLR GD RXWUD PmR )RQWH UTXLYR GRV DXWRUHV

► 1D UHJLmR GR KLSRJiVWUR SUHVVLRQDQGR SDUD DYDOLDU
• Posição do útero (anteverso
exão ou retroverso- exão).
• 7DPDQKR GR WHUR
FIGURA 2.27 – Toque bimanual ou combinado.
Após realizar o toque vaginal é necessário classi car:
exão, médio verso- • RQVLVWrQFLD H HVSHVVXUD GD SDUHGH
• 0RELOL DomR
• 2ULItFLR H WHUQR SXQWLIRUPH HQWUHDEHUWR HWF
• 3RVLomR GR WHUR
• QH RV SDOSiYHLV RX QmR GRORURVRV RX QmR YROXPH
QRUPDO RX QmR SUHVHQoD RX QmR GH WXPRU
• 6HQVLELOLGDGH
Descrição siológica: consistência do colo broelástica,
SDUHGH VHP WXPRUDomR PRELOL DomR GR FROR QmR UHIHUH
dor), orifício fechado, posição do útero em (anteverso exão,
medioverso exão, retroverso exão) e anexos livres.
Observação: HP SDFLHQWHV PDJUDV RV RYiULRV SRGHUmR VHU
SDOSDGRV PDV DV WXEDV VRPHQWH VH HVWLYHUHP DXPHQWDGDV GH
YROXPH SLR RX KLGURVVDOStQJH

)RQWH UTXLYR GRV DXWRUHV

► 2V GHGRV TXH HVWmR QD YDJLQD SUHVVLRQDP RV IyUQLFHV

ODWHUDLV H D RXWUD PmR SUHVVLRQD DV IRVVDV LOLDFDV GLUHLWD
e esquerda para veri car a presença de:
 WHQGlPHQWR
5()(5ç1 6

=8/ < 5 HUPdWROR ld HG 5LR GH -DQHLUR XDQDEDUD

.RRJDQ
% 6726
S
1Ro HV GH lQHfROR ld HG 6mR 3DXOR 3Up QdWdO
WKHQHX D L D OR D DGR
D G PR LP
%5 6,/ 0LQLVWpULR GD 6D GH (VWUdWp ldV SdUd R fxlGdGR Gd PD GD D R GD R D
SHVVRd fRP GRHQod fU Qlfd KLSHUWHQVmR DUWHULDO VLVWrPLFD M D LPR G D D R
%UDVtOLD 0LQLVWpULR GD 6D GH DGHUQRV GD WHQomR D D D GR R O R
EiVLFD Q
,6 ,3/,1 ( 6 ( 0 7(512 ,1) 17,/ QdPQHVH H
H dPH I VlfR lQHfRO lfR +RVSLWDO 6mR /XFDV GD 38 56 QWURGxomR
5LR UDQGH GR 6XO
2 SUp QDWDO WHP FRPR REMHWLYR JDUDQWLU R SURJUHGLU
)(%5 6 2 Ginecologia e Obstetrícia: IHEUDVJR SDUD PpGLFR
siológico da gestação, diminuindo os riscos e a ocorrência de
UHVLGHQWH HG 0DQROH
FRPSOLFDo HV GXUHQWH HVVH SHUtRGR H QR PRPHQWR GR SDUWR V
+2))0 1 % / lQHfROR ld GH lOOldPV HG 3RUWR DOHJUH FRQVXOWDV WHP R LQWXLWR GH SURPRYHU D VD GH GD JHVWDQWH H GD
0 + S FULDQoD H DR PHVPR WHPSR IRUQHFHU DVVLVWrQFLD SVLFRVVRFLDO
32572 32572 / 6HPlROR ld 0pGlfd HG 5LR GH DWLYLGDGHV HGXFDWLYDV H SUHYHQWLYDV jV PXOKHUHV TXH SUHFLVDUHP
-DQHLUR XDQDEDUD .RRJDQ S XQLGDGH EiVLFD GH VD GH 8%6 GHYH VHU D SRUWD GH
32572 32572 / 6HPlROR ld 0pGlfd HG 5LR GH HQWUDGD GD JHVWDQWH QR VLVWHPD GH VD GH JDUDQWLQGR R
-DQHLUR XDQDEDUD .RRJDQ S DFRPSDQKDPHQWR FRQWLQXDGR H ORQJLWXGLQDO GD PHVPD GXUDQWH
WRGD D JUDYLGH 3DUD TXH LVVR VHMD SRVVtYHO p QHFHVViULD D
:RUOG +HDOWK 2UJDQL DWLRQ Obesity: preventing and
UHDOL DomR GR FDGDVWUR QD XQLGDGH GH VD GH H SUHHQFKLPHQWR
PdQd lQ W H ORedO HSlGHPlf 5HSRUW RI D :RUG +HDOWK
GR DUWmR GD HVWDQWH SUHIHUHQFLDOPHQWH QR WULPHVWUH GD
2UJDQL DWLRQ RQVXOWDWLRQ HQHYD :+2
JUDYLGH SDUD TXH LQWHUYHQo HV RSRUWXQDV SRVVDP VHU WRPDGDV
GHVGH R LQtFLR GR SHUtRGR JHVWDFLRQDO VHMDP HODV SUHYHQWLYDV RX
WHUDSrXWLFDV 7DPEpP p JDUDQWLGR R DWHQGLPHQWR GD WRWDOLGDGH
GDV SXpUSHUDV H UHFpP QDVFLGRV FDGDVWUDGRV
V FRQVXOWDV GH SUp QDWDO DEUDQJHP D DQDPQHVH
REVWpWULFD R H DPH ItVLFR JLQHFROyJLFR D VROLFLWDomR GH H DPHV
FRPSOHPHQWDUHV LQGLFDGRV RV FXLGDGRV FRP D LPXQL DomR H D
RIHUWD GH PHGLFDPHQWRV QHFHVViULRV FRPR VXOIDWR IHUURVR H
iFLGR IyOLFR DOpP GD DYDOLDomR GR HVWDGR QXWULFLRQDO
VVLP HPERUD R SUp QDWDO VHMD R SULQFLSDO UHVSRQViYHO SHOR
acompanhamento e identi cação de riscos gestacionais, ele
WDPEpP IXQFLRQD FRPR IHUUDPHQWD HGXFDWLYD Mi TXH LQFHQWLYD
R SDUWR QRUPDO R DOHLWDPHQWR PDWHUQR H RV KiELWRV GH YLGD
saudáveis; identi ca sinais de alarme durante a gestação e sinais
GR WUDEDOKR GH SDUWR RIHUHFH RULHQWDo HV SDUD RV FXLGDGRV GR
UHFpP QDVFLGR DOHUWD D LPSRUWkQFLD GR DFRPSDQKDPHQWR SUp
QDWDO GD FRQVXOWD GH SXHUSpULR H GR SODQHMDPHQWR IDPLOLDU H
por m, informa sobre os direitos da gestante e do pai, sobre
RV ULVFRV GR WDEDJLVPR H GR XVR GH iOFRRO H GD DXWRPHGLFDomR
GXUDQWH D JHVWDomR
2 DWHQGLPHQWR SVLFROyJLFR p IRUQHFLGR D JHVWDQWHV YtWLPDV
GH YLROrQFLD GH TXDOTXHU WLSR VHMD GRPpVWLFD ItVLFD VH XDO
RX SVLFROyJLFD H jTXHOD HP ULVFR GH GHSUHVVmR SyV SDUWR
referenciando-as para equipes ou serviços especí cos.
• 0DQLIHVWDo HV FOtQLFDV QiXVHDV Y PLWRV PDWLWXQRV
WRQWXUDV VDOLYDomR H FHVVLYD PXGDQoD GH DSHWLWH
SRODFL ULD IDGLJD H VRQROrQFLD
• Modi cações anatômicas: aumento do volume mamário
H GD VXD KLSHUVHQVLELOLGDGH FRP D VDtGD GR FRORVWUR
H R DSDUHFLPHQWR GRV WXEpUFXORV GH 0RQWJRPHU
FRORUDomR YLROiFHD YXOYDU FLDQRVH YDJLQDO H FHUYLFDO
DOpP GR DXPHQWR GR YROXPH DEGRPLQDO
6 1 6 ( 352 / ( ( 5 (

2 SURJUDPD GH 3Up QDWDO GHYH FRQWDU FRP XPD HTXLSH • PROHFLPHQWR GD FpUYLFH XWHULQD H SRVWHULRU DXPHQWR
multipro ssional, composta por, no mínimo, um médico GH YROXPH
JLQHFRORJLVWD REVWUHWD XP HQIHUPHLUR H XP FLUXUJLmR GHQWLVWD • XPHQWR GDV SDUHGHV YDJLQDLV H GH VXD YDVFXODUL DomR
SUp QDWDO QD JHVWDomR GH EDL R ULVFR VHQGR GHYLGDPHQWH
• + SRVLWLYR QR VRUR PDWHUQR D SDUWLU GR RX
HQFDPLQKDGD TXDQGR QHFHVViULR SDUD RXWUDV HVSHFLDOLGDGHV
GLD DSyV D IHUWLOL DomR
ld Q VWlfR Gd Ud lGH 6 1 6 ( (57( ( 5 (

2 WHVWH UiSLGR GH JUDYLGH IRL LQFOXtGR FRPR WHVWH GH • %DWLPHQWRV FDUGtDFRV IHWDLV % ) SUHVHQWHV
WULDJHP QD URWLQD GH H DPHV GR SUp QDWDO SRLV R PHVPR SRGH GHWHFWDGRV SHOR 6RQDU GRSSOHU D SDUWLU GH VHPDQDV
VHU UHDOL DGR QD SUySULD 8%6 DFHOHUDQGR R SURFHVVR SDUD H SHOR 3LQDUG D SDUWLU GH VHPDQDV GH JHVWDomR
con rmação da gravidez e início do pré-natal. O mesmo torna- • 0RYLPHQWRV IHWDLV DWLYRV 0) D SDUWLU GD RX
VH UHDJHQWH DSyV GLDV GH DWUDVR GR FLFOR PHQVWUXDO VHPDQDV
O beta-HCG (gonadotro na coriônica humana) quando • Ultrassonogra a.
indicado, é utilizado como diagnóstico con rmatório e precoce Após a con rmação da gravidez, a gestante é cadastrada
GD JUDYLGH (VVH KRUP QLR SRGH VHU GHWHFWDGR QR VDQJXH QR 6LV3UH1DWDO H GDUi LQtFLR DR VHX DFRPSDQKDPHQWR
SHULIpULFR FHUFD GH XPD VHPDQD DSyV D FRQFHSomR D SDUWLU
GLVVR VXD FRQFHQWUDomR VpULFD DXPHQWD DWLQJLQGR R SLFR HQWUH
D GLDV GXUDQWH D JHVWDomR iOfxORV
A ultrassonogra a (USG) pode ser solicitado para o CÁLCULO DA IDADE GESTACIONAL (IG):
GLDJQyVWLFR GH FHUWH D GD JUDYLGH FRPR WDPEpP GHQWUH
• DWD GD FRQVXOWD LD GD OWLPD 0HQVWUXDomR 80
RXWURV YiULRV IDWRUHV SDUD D GHWHUPLQDomR GD LGDGH JHVWDFLRQDO
,GDGH HVWDFLRQDO
HPEULRQiULD H RX IHWDO R TXH p GH VXPD LPSRUWkQFLD Mi TXH
PXLWDV YH HV D GDWD GD OWLPD PHQVWUXDomR 80 p UHODWDGD Exemplo: 20/04/16 (data da consulta) – 04/01/16 (DUM)
LQFRUUHWDPHQWH LPSRVVLELOLWDQGR R FiOFXOR UHDO GD GDWD SURYiYHO VHPDQDV H GLDV
GR SDUWR 33 H GD ,GDGH JHVWDFLRQDO ,
CÁLCULO DA DATA PROVÁVEL DO PARTO (DPP):
6 1 6 ( 35(6 1 2 ( 5 ( ► 5HJUD GH 1DJHOH
• WUDVR PHQVWUXDO • LD GD OWLPD 0HQVWUXDomR 80
 • 0rV ► 1D SULPHLUD FRQVXOWD GD JHVWDQWH GHYHUmR VHU IRUQHFLGRV
• O Cartão da Gestante, com a identi cação preenchida,
R Q PHUR GR DUWmR 1DFLRQDO GD 6D GH R KRVSLWDO GH
UHIHUrQFLD SDUD R SDUWR H DV RULHQWDo HV VREUH
• 2 FDOHQGiULR GH YDFLQDV H VXDV RULHQWDo HV
• VROLFLWDomR GRV H DPHV GH URWLQD
• V RULHQWDo HV VREUH D SDUWLFLSDomR QDV DWLYLGDGHV
HGXFDWLYDV UHXQL HV H YLVLWDV GRPLFLOLDUHV
,QLFLDOPHQWH DV FRQVXOWDV GHYHUmR VHU PHQVDLV DWp D
VHPDQD SRVWHULRUPHQWH TXLQ HQDLV HQWUH D HD VHPDQD
e, por m, semanais no termo (após 37ª semana).
FIGURA 3.1 – Caderneta da Gestante.
► )LFKD GH DYDOLDomR GR ULVFR JHVWDFLRQDO
1D SULPHLUD FRQVXOWD SUp QDWDO LUi VH HVWDEHOHFHU D
classi cação do risco gestacional – realizado posteriormente
em toda consulta – e o encaminhamento, quando necessário,
DR SUp QDWDO GH DOWR ULVFR RX j XUJrQFLD HPHUJrQFLD REVWpWULFD
FRP REMHWLYR GH UHGX LU D PRUELPRUWDOLGDGH PDWHUQR LQIDQWLO

)RQWH 0LQLVWpULR GD 6D GH

3UlPHlUd fRQVxOWd

• 1 PHUR PtQLPR GH FRQVXOWDV PpGLFRH HQIHUPDJHP

• Idade “ideal” para gestação: 18 – 34 anos.
FIGURAS 3.2 – Ficha de seleção de risco gestacional (frente). FIGURAS 3.3 – Ficha de seleção de risco gestacional (verso).

)RQWH 6HFUHWDULD H HFXWLYD GR (VWDGR GR 3DUi GH 6D GH 3 EOLFD )RQWH 6HFUHWDULD H HFXWLYD GR (VWDGR GR 3DUi GH 6D GH 3 EOLFD
 1 01(6( 2 67 75 3DUD LQtFLR GR SUp QDWDO
HQWUH VHPDQDV
UHDOL DU 727 J HQWUH D
,WHP GHVFULWR QR FDStWXOR GH DQDPQHVH REVWpWULFD H VHPDQD GRVDJHQV
MHMXP KRUD H KRUD

( 0( ) 6 2 3DUD R LQtFLR GR SUp QDWDO

VHPDQDV UHDOL DU
727 J LPHGLDWDPHQWH
,WHP GHVFULWR QR FDStWXOR GH H DPH ItVLFR REVWpWULFR GRVDJHQV MHMXP KRUD
H KRUD
LQWHUSUHWDomR IHLWD SDUD R
( dPHV fRPSOHPHQWdUHV 727 J VHUi D VHJXLQWH
• Se estiver com alguma
75 0(675(
75 0(675( 75 0(675( 2eVHU do HV GDV GRVDJHQV HQWUH HVVHV
Rx 216 /7 SDUkPHWURV UHFHEHUi
GLDJQyVWLFR GH LDEHWHV
YDOLDU SUHVHQoD GH DQHPLD
0HOOLWXV HVWDFLRQDO 0
+E J G/ QRUPDO
-HMXP D PJ G/
+E HQWUH J G/
+HPRJUDPD +HPRJUDPD - após 1ª hora: ≥ 180 mg/
DQHPLD OHYH D PRGHUDGD G/
+E J G/ DSyV KRUD D
DQHPLD JUDYH PJ G/
(P FDVR GH • Agora caso esteja dentro
GHVVHV UHFHEHUi GLDJQyVWLFR
0mR 5K QHJDWLYR H GH LDEHWHV 0HOOLWXV 0
SDUFHLUR 5K SRVLWLYR RX GLDJQRVWLFDGR QD JHVWDomR
7LSDJHP VDQJXtQHD H 0mH 5K QHJDWLYR - Jejum: ≥ 126 mg/dL
IDWRU 5K H SDUFHLUR FRP 5K - 2ª hora: ≥ 200 mg/dL
GHVFRQKHFLGR
7HVWH UiSLGR GH
HYH VH VROLFLWDU WHVWH GH 7HVWH UiSLGR GH WULDJHP SDUD
RRPEV LQGLUHWR triagem para sí lis ou sí lis ou VDRL
4XDQGR R UHVXOWDGR GR WHVWH 9 5/
VHPDQD
IRU QHJDWLYR GHYH VH UHSHWL OR
D FDGD VHPDQDV D SDUWLU GD
RRPEV LQGLUHWR RRPEV LQGLUHWR 7HVWH UiSLGR SDUD +,9 7HVWH UiSLGR SDUD
RRPEV LQGLUHWR VH VHPDQD
VH PmH 5K VH PmH 5K RX 6RURORJLD +,9 RX 6RURORJLD
PmH 5K QHJDWLYR DVR VHMD SRVLWLYR D JHVWDQWH
QHJDWLYR QHJDWLYR QWL +,9 , H ,, QWL +,9 , H ,,
GHYH VHU HQFDPLQKD SDUD R
DWHQGLPHQWR SUp QDWDO GH DOWR
ULVFR 6RURORJLD SDUD
6RURORJLD SDUD
KHSDWLWH %
KHSDWLWH % +EV J
3DUD LQtFLR GH SUp +EV J
QDWDO VHPDQDV
UHDOL DU JOLFHPLD GH MHMXP 7R RSODVPRVH
LPHGLDWDPHQWH DYDOLDQGR RV 7R RSODVPRVH ,J0 H VH ,J0 H ,J
7HVWH GH VHJXLQWHV UHVXOWDGRV ,J QmR UHDJHQWH QR
WROHUkQFLD SDUD
• Se ≥ 126 mg/dL = VHPHVWUH
JOLFRVH FRP
LDEHWHV 0HOOLWXV 0
J OLFHPLD HP GLDJQRVWLFDGR QD JHVWDomR JHVWDQWH VHJXH D URWLQD
OLFHPLD HP MHMXP
SUHIHUHQFLDO MHMXP GH UDVWUHDPHQWR GR FkQFHU
• Entre 92 e 125 mg/dL =
PHQWH HQWUH D GH FROR GR WHUR FRPR DV
LDEHWHV 0HOOLWXV HVWDFLRQDO
HD VH GHPDLV PXOKHUHV GHYHQGR
0 LWRSDWROyJLFR GR FROR
PDQD UHDOL DU FROHWD DQXDOPHQWH
• < 92 mg/dL = Realizar GH WHUR
HVVH PRGR FDVR REWHQKD
7HVWH GH 7ROHUkQFLD 2UDO D UHVXOWDGRV QHJDWLYRV
OLFRVH 727 J HQWUH D FRQVHFXWLYRV SDVVD D
H VHPDQD UHDOL i OR D FDGD DQRV
 %DFWHULRVFRSLD HQWUH RV H DPHV GH URWLQD SUp QDWDO GHYH VH FRQVLGHUDU
GH VHFUHomR DV SULRULGDGHV H RV SURWRFRORV GRV JHVWRUHV GH GHWHUPLQDGDV
%DFWHULRVFRSLD GH YDJLQDO
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Fonte: Ministério da Saúde – Caderneta da Gestante, 2016.

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Fonte: Ministério da Saúde – Caderneta da Gestante, 2016.

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modi cados pela gestação. Também é importante
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número de lhos).
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– no 3º ao 5º dia – desaparecendo em poucos dias
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menstruação) e DPP (data provável do parto) – veri car
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– já essas substâncias apresentam componentes que
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decorrer do dia. Mesmo com tratamento, di cilmente
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FUHVFLPHQWR IHWDO GDV DOWHUDo HV QR YROXPH GH OtTXLGR DPQLyWLFR
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JHVWDomR
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163( 2 (5 /

Avaliar: HVWDGR HPRFLRQDO FRQGLo HV QXWULFLRQDLV

• Sinais vitais, altura e peso
• Temperatura: HP PpGLD PDLRU GR TXH D
EDVDO
• Respiração: DWHQomR SULQFLSDOPHQWH SDUD R OWLPR
 WULPHVWUH GH JHVWDomR SRLV R FUHVFLPHQWR XWHULQR 90 – 92cm em gestantes a termo e não obesas.
HOHYD R GLDIUDJPD R TXH SRGH OHYDU D XP TXDGUR GH • Face: SUHVHQoD GR ORDVPD RX 0HODVPD SLJPHQWDomR
GLVSQHLD HVFXUD GLIXVD RX FLUFXQVFULWD QDV UHJL HV PDLV
• 3xOVR H SRVWDV DR VRO FRPR QDUL UHJLmR IURQWDO H
• Pressão arterial (PA): TXDGURV KLSHUWHQVLYRV LJRPiWLFD
FRPR KLSHUWHQVmR JHVWDFLRQDO KLSHUWHQVmR FU QLFD H FIGURA 5.1– Cloasma ou Melasma.
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e, em virtude disso, a veri cação da pressão arterial
GHYH VHU XPD FRQVWDQWH HP WRGdV DV FRQVXOWDV GH
SUp QDWDO 3 LGHDOPHQWH GHYH HVWDU DEDL R GH
PP+J DVR D 3 VHMD FRQKHFLGD D VLVWyOLFD
QmR SRGH XOWUDSDVVDU PP+J GR QRUPDO H D
GLDVWyOLFD PP+J
• Hipertensão gestacional: SUHVVmR UWHULDO 6LVWyOLFD
(PAS) ≥ 140 e Pressão Arterial Diastólica (PAD) ≥ 90.
6XUJLPHQWR DSyV D VHPDQD GH JHVWDomR H VHP
SURWHlQ Uld
• Hipertensão crônica: PAS ≥ 140 e PAD ≥ 90 antes
GD JUDYLGH DQWHULRU D VHPDQD GH JHVWDomR H
DSyV D VHPDQD GH SyV SDUWR
• Pré-eclâmpsia: PAS ≥ 140 e PAD ≥ 90. Surgimento )RQWH UTXLYR GRV DXWRUHV
DSyV D VHPDQD GH JHVWDomR H fRP SURWHlQ Uld
OpP GD SURWHLQ ULD H KLSHUWHQVmR Ki HGHPD • Olhos: REVHUYDU D FRORUDomR GDV FRQMXQWLYDV D
JHVWDQWH SRVVXL XPD WHQGrQFLD j DQHPLD TXDGUR
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GH KHPRGLOXLomR SRU DXPHQWR GR YROXPH SODVPiWLFR
SUp HFOkPSVLD SRUpP FRP R DFUpVFLPR GH FRQYXOVmR
conhecido como anemia siológica da gestação,
• 2 SHVR H d dOWxUd GD SDFLHQWH VmR IXQGDPHQWDLV GHYLGR j TXHGD GR KHPDWyFULWR H GD KHPRJORELQD
SDUD GHWHUPLQDU R tQGLFH GH PDVVD FRUSRUDO ,0 H
• Boca: DYDOLDU JHQJLYDV H GHQWHV (P UHODomR DRV
SRU FRQVHTXrQFLD R HVWDGR QXWULFLRQDO 7UDWDQGR VH
OWLPRV VDEH VH TXH LQIHFo HV SRGHP OHYDU j
mais especi camente do peso, sabe-se que o ganho
SUHPDWXULGDGH H D EDL R SHVR DR QDVFLPHQWR
DGHTXDGR SDUD XPD SDFLHQWH VHJXQGR R 0LQLVWpULR
da Saúde, ca no intervalo de 11,5 e 16 kg. • Tireoide: p HVSHUDGR XP GLVFUHWR DXPHQWR VLPpWULFR
GD JOkQGXOD GHYLGR D HIHLWRV KRUPRQDLV PDLV HYLGHQWH
Observação: D SDUWLU GD D
VHPDQD GH JHVWDomR 3RUWDQWR
QR SULPHLUR WULPHVWUH SRU FRQWD GH QiXVHDV H Y PLWRV D JUiYLGD VHPSUH LQVSHFLRQDU H SDOSDU D WLUHRLGH
SRGH DSUHVHQWDU XPD SHUGD GH DWp GR SHVR DVR H FHGD • Tórax e pulmões: QD JUDYLGH D SDUWLU GRV DXPHQWRV
HVVH YDORU GHQWUR GHVVDV FLUFXQVWkQFLDV VXVSHLWDU GH KLSHUrPHVH FUHVFHQWHV GH SURJHVWHURQD Ki XP DXPHQWR GR
JUDYtGLFD 1R VHJXQGR H WHUFHLUR WULPHVWUHV Ki JDQKR GH J YROXPH FRUUHQWH H GD YHQWLODomR PLQXWR DOYHRODU R TXH
SRU VHPDQD SRGH OHYDU j GLVSQHLD H j DOFDORVH UHVSLUDWyULD )RUD
• Circunferênciaabdominal:PHGH DSUR LPDGDPHQWH LVVR LQYHVWLJDU VLQDLV FRPR WRVVH H RX GHVFRQIRUWR
 UHVSLUDWyULR SDUD R GLDJQyVWLFR SUHFRFH GH DVPD RX ( dPH ReVWpWUlfR
HPEROLD SXOPRQDU
eGRPH – gestante em decúbito horizontal.
( dPH GdV PdPdV
1R H DPH ItVLFR GR DEGRPH D VHJXLQWH VHTXrQFLD GHYH
► RP VHPDQDV GH JHVWDomR VHU REHGHFLGD LQVSHomR DOWXUD XWHULQD SDOSDomR PDQREUDV GH
/HRSROG =ZHLIHO H DXVFXOWD IHWDO
• Congestão mamária: hipertro a.
• UpROD SULPiULD DUpROD KLSHUSLJPHQWDGD 163( 2
• 7XEpUFXORV GH 0RQWJRPHU JOkQGXODV
► Veri car o formato do abdome (plano, abaulado, ovoide
mamárias acessórias ou sebáceas hipertro adas.
RX JORERLGH
► RP VHPDQDV GH JHVWDomR
Atentar também para modi cações na pele, como a
• RORVWUR OtTXLGR TXH VDL GD PDPD H SUHFHGH R OHLWH presença de:
materno. É possível veri car com a expressão.
• LFDWUL HV LQYHVWLJDU FLUXUJLD GH FHViUHD DQWHULRU
• 5HGH YHQRVD GH +DOOHU DXPHQWR GD FLUFXODomR YHQRVD
• 0HODVPD RX FORDVPD
IRUPDQGR XPD UHGH YLVtYHO VRE D SHOH WUDQVSDUHQWH
GDV PDPDV • Estrias (que são rupturas de bras elásticas; quando
UHFHQWHV VmR YHUPHOKDV RX D XODGDV H TXDQGR
► RP VHPDQDV GH JHVWDomR
WDUGLDV EUDQFDV
• 6LQDO GH +XQWHU GHVHQYROYLPHQWR GD DUpROD
• /LQKD LJ D HVFXUHFLPHQWR GD OLQKD DOED
VHFXQGiULD HVFXUHFLPHQWR GDV PDPDV
• (GHPD
FIGURA 5.2 – Gestante com mais de 20 semanas de gestação:
• XPHQWR H DJHUDGR GR YROXPH DEGRPLQDO LQGLFDWLYR
SUHVHQoD GH DUpROD SULPiULD WXEpUFXORV GH 0RQWJRPHU UHGH
GH DOWHUDo HV LPSRUWDQWHV SROLGUkPQLR JHPHODULGDGH
YHQRVD GH +DOOHU H 6LQDO GH +XQWHU
H REHVLGDGH
Observação: R IRUPDWR WHQGH D VHU PDLV SrQGXOR HP PXOWtSDUDV
SHOR HQIUDTXHFLPHQWR GD PXVFXODWXUD DEGRPLQDO R TXH SRGH
JHUDU DOWHUDo HV GH DSUHVHQWDomR IHWDO

3 /3 2

► Veri car a consistência uterina:

• tVWLFD OtTXLGR DPQLyWLFR
• (OiVWLFD SDUHGH XWHULQD
• 3DVWRVD SODFHQWD

0( /7 5 7(5 1
)RQWH UTXLYR GRV DXWRUHV
Com a mão direita, xar a extremidade inicial (0 cm) da ta
métrica, exível e não extensível, na borda superior da sín se FIGURA 5.4 – Medida do fundo uterino com ta métrica entre os
S ELFD SDVVDQGR D HQWUH RV GHGRV LQGLFDGRU H PpGLR GD PmR GHGRV LQGLFDGRU H PpGLR GD PmR HVTXHUGD
HVTXHUGD RX SHOD ERUGD FXELWDO HVTXHUGD 3URFHGHU j OHLWXUD
TXDQGR D ERUGD FXELWDO GD PmR DWLQJLU R IXQGR XWHULQR

Observações:
• Fundo uterino abaixo da a IG (Idade gestacional) –
VXVSHLWDU SULPHLUR GH HUUR GH GDWD FiOFXOR GD LGDGH
JHVWDFLRQDO HUUDGR ROLJRGUkPQLR RX FUHVFLPHQWR
LQWUDXWHULQR UHVWULWR
• )XQGR XWHULQR JUDQGH SDUD D , HUUR GH GDWD RX
SROLGUkPQLR RX GLDEHWHV JHVWDFLRQDO IHWR JUDQGH SDUD
LGDGH JHVWDFLRQDO ,
• 4XDQGR D GDWD H R SHUtRGR GD OWLPD PHQVWUXDomR
VmR GHVFRQKHFLGRV SRGH VH XVDU D DOWXUD XWHULQD SDUD
HVWLPDU D LGDGH JHVWDFLRQDO )RQWH UTXLYR GRV DXWRUHV

FIGURA 5.3 – Medida do fundo uterino com ta métrica na borda Na 12ª semana: WHUR HQFKH D SHOYH GH PRGR TXH p SDOSiYHO
FXELWDO GD PmR HVTXHUGD na borda superior da sín se púbica; útero se torna abdominal.
Na 16ª semana: o fundo uterino encontra-se entre a sín se
S ELFD H D FLFDWUL XPELOLFDO
Na 20ª semana: R IXQGR GR WHUR HQFRQWUD VH QD DOWXUD GD
FLFDWUL XPELOLFDO
A partir da 20ª semana: H LVWH UHODomR GLUHWD HQWUH DV VHPDQDV
GD JHVWDomR H D PHGLGD GD DOWXUD XWHULQD 3RUpP HVVH SDUkPHWUR
torna-se menos el a partir da 30ª semana de idade gestacional.
Na 40ª semana: R WHUR VH HQFRQWUD DR QtYHO GR DSrQGLFH
LIyLGH
QWHV GH LQLFLDU DV PDQREUDV GH /HRSROG XPD UHYLVmR VREUH
HVWiWLFD IHWDO GHYH VHU IHLWD SDUD UHOHPEUDU FRQFHLWRV LPSRUWDQWHV
Situação: UHODomR HQWUH R PDLRU HL R GR IHWR H PDLRU HL R GR
XWHULQR 3RGH VHU ORQJLWXGLQDO WUDQVYHUVD RX REOtTXD
)RQWH UTXLYR GRV DXWRUHV
• /RQJLWXGLQDO PDLRUHV HL RV GR IHWR H WHUR VmR
SDUDOHORV H FRLQFLGHP
• 7UDQVYHUVD PDLRUHV HL RV GR IHWR H WHUR VmR
SHUSHQGLFXODUHV
• 2EOtTXD RX LQFOLQDGD PDLRUHV HL RV GR IHWR H WHUR
 VH FUX DP
SUHVHQWdomR UHJLmR GR IHWR TXH VH HQFRQWUD YROWDGD SDUD R FIGURA 5.5 –1º Tempo da manobra de Leopold-Zweifel.
HVWUHLWR VXSHULRU OLQKD HQWUH R SURPRQWyULR H PDUJHP VXSHULRU
da sín se púbica). Pode ser cefálica, pélvica ou córmica.
• HIiOLFD SROR FHIiOLFR
• Pélvica: polo pélvico – pelve ou membros inferiores
FRPSOHWD RX LQFRPSOHWD
• yUPLFD RPEUR VHPSUH DSUHVHQWDomR GD VLWXDomR
WUDQVYHUVD
Altura da Apresentação: pode ser móvel ou xa.
• 0yYHO RX DOWD
• )L D RX LQVLQXDGD RX HQFDL DGD

3 /3 2

► 1D SDOSDomR HQWmR GHVWDFDP VH RV TXDWUR WHPSRV GDV

PdQReUdV GH /HRSROG ZHlIHO
1º tempo: H SORUDomR GR IXQGR XWHULQR GHOLPLWDQGR R H
FDUDFWHUL DQGR RQGH RV VHJPHQWRV IHWDLV VH HQFRQWUDP (VWH
WHPSR RULHQWD TXDQWR j VlWxdomR H j dSUHVHQWdomR IHWdO
3DOSDomR FRP DV ERUGDV FXELWDLV GH DPEDV DV PmRV QR IXQGR
XWHULQR GHOLPLWDQGR VHP SUHVVLRQDU PXLWR H VHQWLQGR FRP D
IDFH SDOPDU TXDO R SROR SUHVHQWH QR IXQGR XWHULQR SpOYLFR RX
cefálico) – orientação em relação à apresentação fetal. O polo
SpOYLFR p PDLV YROXPRVR HVIHURLGH LUUHJXODU PDV UHGXWtYHO H
VHP UHFKDoR -i R SROR FHIiOLFR p PHQRU UHJXODU UHVLVWHQWH H
LUUHGXWtYHO
3RGH VH WDPEpP YHU QHVVH WHPSR R UHf doR GHSHQGHQGR
GD TXDQWLGDGH GH OtTXLGR DPQLyWLFR UHFKDoR p PXLWR PDLV QtWLGR
FRP R SROR FHIiOLFR
• 5Hf doR VlPSOHV GHVORFD R SROR IHWDO H HOH GHL D
GH VHU SDOSiYHO
• 5Hf doR GxSOR GHVORFD R SROR IHWDO H GHSRLV HOH
YROWD SDUD SRVLomR LQLFLDO YROWDQGR D VHU SDOSiYHO
)RQWH UTXLYR GRV DXWRUHV
Observação:
2 IHWR SRGH HVWDU HP VLWXDomR ORQJLWXGLQDO PDLV FRPXP RX
WUDQVYHUVD VLWXDomR WUDQVYHUVD UHGX D PHGLGD GH DOWXUD
XWHULQD SRGHQGR IDOVHDU VXD UHODomR FRP D LGDGH JHVWDFLRQDO V
DSUHVHQWDo HV TXDQGR R IHWR HVWi HP VLWXDomR ORQJLWXGLQDO VmR D
FHIiOLFD H D SpOYLFD
2º tempo: H SORUDomR GR GRUVR IHWDO YLVD GHWHUPLQDU D SRVlomR
IHWdO UHFRQKHFHQGR FRP DV PmRV R ODGR RFXSDGR SHOR GRUVR
GR IHWR VHJPHQWR HQGXUHFLGR H FRQYH R H R ODGR RQGH HVWmR
RV PHPEURV IHWDLV
SDOSDomR p IHLWD DR GHVOL DU DV PmRV GR IXQGR XWHULQR HP
GLUHomR DR SROR LQIHULRU ODWHUDOPHQWH
• Primeira posição: R IHWR HVWi HP SRVLomR HVTXHUGD
RX VHMD VHX GRUVR HVWi QR ODGR HVTXHUGR PDWHUQR
• Segunda posição: R GRUVR IHWDO HVWi GR ODGR GLUHLWR
PDWHUQR
FIGURA 5.6 – 2º Tempo da manobra de Leopold-Zweifel. 4º tempo: exploração da escava (con rma situação,
dSUHVHQWdomR H dOWxUd
2 H DPLQDGRU GH FRVWDV SDUD D FDEHoD GD SDFLHQWH
HVSDOPD DV PmRV VREUH DV IRVVDV LOtDFDV H DV GHVORFD HP GLUHomR
DR KLSRJiVWULR SDUDOHODPHQWH j DUFDGD FUXUDO RP DV SRQWDV
GRV GHGRV SURFXUD SHQHWUDU QD SHOYH SDUD DYHULJXDU R JUDX GH
SHQHWUDomR GR SROR DSUHVHQWDGR QR HVWUHLWR VXSHULRU GD EDFLD
HVWD PDQHLUD SRGH VH WDPEpP UHFRQKHFHU D FDEHoD IHWDO
TXH RFXSD FRPSOHWDPHQWH D HVFDYD H p XP FRUSR YROXPRVR
GH VXSHUItFLH UHJXODU UHVLVWHQWH H LUUHGXWtYHO RX R SROR SpOYLFR
TXH RFXSDQGR SDUFLDOPHQWH D HVFDYD p FRUSR PDLV YROXPRVR
HVIHURLGH GH VXSHUItFLH LUUHJXODU UHVLVWHQWH PDV UHGXWtYHO
HVFDYD YD LD VXJHUH DSUHVHQWDomR FyUPLFD WUDQVYHUVD

FIGURA 5.8 – 4º Tempo da manobra de Leopold-Zweifel.

)RQWH UTXLYR GRV DXWRUHV

3º tempo: H SORUDomR GD PRelOlGdGH GR SROR IHWdO dOWxUd

Gd dSUHVHQWdomR TXH HVWi QR HVWUHLWR VXSHULRU SURFXUD VH
DSUHHQGHU R SROR HQWUH R SROHJDU H R GHGR PpGLR LPSULPLQGR OKH
PRYLPHQWRV GH ODWHUDOLGDGH TXH LQGLFDP R JUDX GH SHQHWUDomR
na bacia. Quando insinuado, o polo se apresenta xo, quando
PyYHO HVWH VH HQFRQWUD DOWR

FIGURA 5.7–3º Tempo da manobra de Leopold-Zweifel.

)RQWH UTXLYR GRV DXWRUHV

6 /7 )(7 /

2V EDWLPHQWRV FDUGtDFRV IHWDLV % ) SRGHP VHU SHUFHELGRV

pela ultrassonogra a a partir da 7ª e 8ª semana de gestação
(se ultrassonogra a transvaginal, pode-se veri car com até 6
VHPDQDV SHOR 6RQdU GRSSOHU HQWUH H VHPDQDV H SHOR
HVWHWRVf SlR GH 3lQdUG SRU YROWD GD VHPDQD IUHTXrQFLD
)RQWH UTXLYR GRV DXWRUHV
FDUGtDFD IHWDO QRUPDO RVFLOD HQWUH H eSP FRQIRUWiYHO SRVVtYHO UHVSHLWDQGR VHPSUH R SXGRU GD
JHVWDQWH
Observação: SDUD XWLOL DU R 6RQDU RSSOHU DSyV VHPDQDV
SULPHLUDPHQWH DV PDQREUDV GH /HRSROG GHYHP VHU UHDOL DGDV • HQWUH RV VLQDLV TXH VH GHVWDFDP QR H DPH GR FROR
FRP GHVWDTXH SDUD R VHJXQGR WHPSR XPD YH TXH SRU PHLR XWHULQR SRGH VH GHVFUHYHU R VLQDO GH KDGZLFN
dele, há identi cação do dorso fetal. (8 RX VLQDO GH -DFTXHPLHU (XURSD PXFRVD
KLSHUSLJPHQWDGD H WXPHIHLWD GH URVDGD SDUD
), 85 6RQDU RSSOHU % 0RGR GH XVR GR 6RQDU RSSOHU FLDQyWLFD GHYLGR j PXGDQoD KRUPRQDO H PHFkQLFD
• )RUD R VLQDO GHVFULWR DFLPD GHYH VH LQVSHFLRQDU R
kQXV SHVTXLVDQGR KHPRUURLGDV DV TXDLV SRGHP
OHYDU j GRU H RX VDQJUDPHQWR

724 ( 2 67 75 2

2 WRTXH p R PDLV DPSODPHQWH XWLOL DGR H GLIXQGLGR VHQGR

UHOHYDQWH SDUD R GLDJQyVWLFR GD JHVWDomR QR SULPHLUR WULPHVWUH
H SDUD GHWHUPLQDU D YLJrQFLD GR WUDEDOKR GH SDUWR H D DPSOLWXGH
da pelve. A partir do toque obstétrico, é possível identi car:
• 2 DSDJDPHQWR H D GLODWDomR FHUYLFDO
)RQWH UTXLYR GRV DXWRUHV
• SUHVHQoD RX QmR GD EROVD DPQLyWLFD D VXD
IMPORTANTE: a veri cação da pressão arterial da gestante e LQWHJULGDGH H HYHQWXDOPHQWH D VXD UXSWXUD
R % ) VmR H DPHV TXH MDPDLV SRGHUmR GHL DU GH VHU UHDOL DGRV • DOWXUD GD DSUHVHQWDomR
QDV FRQVXOWDV GH SUp QDWDO
• 2 H DPH GD SHOYH yVVHD FRP D GHWHUPLQDomR GRV
Diagnóstico de apresentação pela ausculta: GLkPHWURV FRQMXJDGRV

► 2 IRFR Pi LPR GH DXVFXOWD HVWi PDLV SUy LPR GR SROR • A con rmação da apresentação.
FHIiOLFR HQWmR TXDQGR D DSUHVHQWDomR p FHIiOLFD HOH • LDJQyVWLFR GD YDULHGDGH GH SRVLomR
HVWi QRV TXDGUDQWHV LQIHULRUHV GR DEGRPH
► 4XDQGR p SpOYLFD HVWi QRV TXDGUDQWHV VXSHULRUHV ( 75(0 (6
H TXDQGR p FyUPLFD HVWi QD OLQKD PpGLD SUy LPR GD
FLFDWUL XPELOLFDO QR WUDEDOKR GH SDUWR R HQFDL H IHWDO • 3HVTXLVD GH YDUL HV
DOWHUD HVVD UHODomR • ,QVSHomR GH PmRV H SHUQDV SHVTXLVDQGR HGHPD

Ausência de batimentos: morte fetal (deve ser con rmada

com uso de sonar-Doppler ou ultrassonogra a).

( 0( 52 (1 7 /

• XUDQWH D LQVSHomR HVWiWLFD GR H DPH JLQHFROyJLFR D

SDFLHQWH GHYH HVWDU HP SRVLomR JLQHFROyJLFD H R PDLV